Ethics in Treating Infectious Diseases: Tuskegee, Guatemala, and Their Legacies
Help Received: Syphilis Module Readings
Ian Horkan
Infectious diseases have a significant and destructive potential to wreak havoc on human populations. As a result, there is a significant drive in the field of medicine to eradicate or effectively neutralize the most prevalent or debilitating of these diseases. However, significant ethical challenges are posed when scientists and medical professionals attempt to confront these diseases. One ethical issue that is presented by infectious diseases is the balance of the needs of the individual vs. the needs of the population. For example, with regards to vaccines there is an ethical issue with violating the rights of an individual and requiring mandatory vaccination for the greater benefit of the population. While this will likely help defend a population against the disease, but it also can subject individuals to complications to vaccines as well as violate their individual right to determine if they want to get the vaccine or not. In addition, mandatory quarantine of individuals can affect many of their rights to freedom of movement and their right against unjust imprisonment but said quarantine will also likely help the population avoid the disease. Another ethical issue that arises from combating infectious disease is that it can often come with an unfair bias against immigrants. This likely comes from the fact that outside populations are perceived as ringing in new diseases, a trend observed after European migration to the New World devastated native populations. There are significant ethical challenges that come with combating infectious disease.
In particular, the Tuskegee Syphilis Study is a clear depiction of ethical compromise in favor of scientific results when studying diseases, one that would have lasting effects on the African-American community. Starting in 1932 the USPHS started a study of 400 African American men who had syphilis. What was originally only supposed to be an 8-month study turned into one that spanned 40 years. Throughout this, the men were never informed that they were being withheld from normal care, an issue that came to a head when drugs that could have cured their syphilis were developed. In addition, the men were told that they were receiving treatment for their syphilis when they were not. One way that Tuskegee was rationalized was that treatments available in 1932 were dangerous, despite evidence showing the opposite. Defenders of the study also claim that subjects of the study would not have received any better treatment if they had not been a part of the study, and that morbidity and mortality rates remained constant. Finally, defenders try to assert that there was no concept in the United States in 1932 about informed consent, however there is evidence of medical codes dating back to 1907 and it does not excuse the USPHS for continuing the study long after the concept of informed consent was established. Morally, one of the most striking things that was unethical about the Tuskegee study was the lack of informed consent, in addition to the fact that subjects were subjected to harm with no clear benefit available.
The legacies of the Tuskegee Syphilis Study have had a significant impact on the African-American Community, particularly in how they perceive the medical community. One particular impact is the distrust it sowed in the African-American community of doctors, possibly reducing life expectancy by 1.4 years. In addition, African-American reluctance to turn to public health officials due to the lasting social effects of Tuskegee have fueled a tuberculosis in nearby Marion. Distrust has also fueled a reluctance of African-Americans to participate in biomedical studies. The lasting effects of Tuskegee have impacted public health officials and doctors ability to interact with the African-American population.